Health Plans | Utilization Management Comprehensive Oncology

eviCore’s Comprehensive Oncology suite combines our capabilities in Medical Oncology, Radiation Oncology, Radiology, and Genomic/Molecular Laboratory to create a holistic, patient-centered care model that integrates pharmacy and medical benefits with regimen-based treatment plans and claims payment integrity to deliver better care at lower costs. Our team of cancer professionals includes over 30 board-certified oncology physicians, 30 nurses, 8 pharmacists, 22 genetic counselors, and more than 150 radiology/cardiology physicians who care deeply about the patients we serve.  Using continually updated evidence-based clinical policies, intuitive clinical decision support software, and peer-to-peer consultations, we help providers choose the right tests and treatments for each unique patient.

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Payers

Our Comprehensive Oncology suite optimizes the use of evidence-based guidelines to ensure the delivery of high-quality care to patients while avoiding the negative side effects and financial toxicity associated with unproven or less effective healthcare services.

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Providers

The Comprehensive Oncology suite helps providers quickly identify the most appropriate evidence-based test and treatment options using each patient’s unique clinical situation and the most up-to-date clinical guidelines.

Patients

Our Comprehensive Oncology suite allows patients to have confidence that the tests and treatments they receive meet the standards established by the leading experts in their cancer type, drawn from top cancer programs across the country. The solution offers the best chance for a positive outcome, and avoidance of the unnecessary costs and side effects associated with inappropriate health services (e.g., protracted therapy or avoidable emergency room visits and hospitalizations).

Frequently Asked Questions

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What is included in eviCore’s Comprehensive Oncology suite?

Our integrated and proven Comprehensive Oncology suite includes the following:

  • The eviCore Medical Oncology, Radiation Oncology, Genomic and Molecular Laboratory, and Radiology solutions
  • NCCN® and eviCore evidence-based clinical guidelines for all cancer types
  • Regimen-based and dynamic clinical decision support designed for provider ease
  • Cost savings without the need to narrow regimens or the provider network
  • Inclusion of all therapeutic and supportive cancer drugs in one episode of care, including those covered under both the pharmacy and medical benefits
  • Electronic transmittal of approved HCPCS and NDC codes
  • Post-service, pre-payment claims review via Claims Studio.